Abstract
PURPOSE: To evaluate and compare the safety, efficacy, and patient-centered outcomes of three enucleation techniques-bipolar transurethral enucleation of the prostate (B-TUEP), thulium laser enucleation (ThuLEP), and robotic-assisted simple prostatectomy (RASP)-in older adult patients (>60 years) with large-volume benign prostatic hyperplasia (BPH >80 cm(3)), a population at increased surgical risk and underrepresented in prior comparative studies. PATIENTS AND METHODS: This study retrospectively analyzed 127 patients aged 60 to 90 years who underwent B-TUEP (n=43), ThuLEP (n=58), or RASP (n=26) between 2014 and 2024. All procedures were performed by a single surgeon. Preoperative and 12-month postoperative outcomes-including IPSS, Qmax, post-void residual (PVR), and quality of life (QoL)-were assessed. Complication profiles, including urinary tract infection (UTI), prolonged analgesic requirement (PAR), and unexpected return visits (URV), were evaluated to reflect real-world risks in the older adults population. RESULTS: All three surgical techniques resulted in significant and sustained improvements in IPSS, Qmax, and PVR, with no significant intergroup differences at 12 months. ThuLEP demonstrated the lowest postoperative pain and analgesic use, RASP had the lowest UTI incidence, and B-TUEP was associated with the shortest operative time. Kaplan-Meier analysis showed comparable long-term medication-free survival across groups (p = 0.085). Quality of life scores improved in all groups, with numerically better outcomes observed in the RASP group. CONCLUSION: In older adult patients with large BPH, B-TUEP, ThuLEP, and RASP all offer effective and durable symptom relief with distinct perioperative advantages. Given the heightened risks associated with aging-including infection, delayed recovery, and medication burden-this study underscores the importance of tailored surgical decision-making in patients over 60. All three techniques are viable, and selection should be guided by individual patient priorities and risk profiles.